When you have ulcerative colitis, it’s normal to have pain in your abdomen, along with diarrhea and other gastrointestinal (GI) symptoms. Up to 30 percent of people with ulcerative colitis also have swollen, painful joints. Joint pain and swelling are the most common non-GI symptoms of ulcerative colitis.

Here’s a look at the connection between ulcerative colitis and arthritis, as well as what you can do to protect your joints if you have ulcerative colitis.

Ulcerative colitis is a type of inflammatory bowel disease (IBD). Joint pain with swelling is the most common non-GI complication of IBD. The reason for the link may lie in genes that make people with IBD more susceptible to arthritis.

Two types of conditions can affect the joints in people with ulcerative colitis. Arthralgiais pain in the joints without any inflammation, or swelling and redness. Arthritis is joint pain with inflammation.

Arthritis that occurs with ulcerative colitis is a bit different than regular arthritis. For one thing, it typically starts at a younger age. Arthritis in people with ulcerative colitis doesn’t usually cause long-term joint damage. The joints swell up and become painful, but they return to normal once intestinal inflammation is under control.

A few different types of arthritis can affect people with ulcerative colitis:

Peripheral arthritis

Peripheral arthritisaffects large joints in the arms and legs, such as the:

  • knees
  • ankles
  • wrists
  • shoulders
  • elbows

The level of pain tends to mirror your ulcerative colitis symptoms, so the more severe your ulcerative colitis is, the more severe your arthritis symptoms will be. Once your bowel symptoms go away, your joint pain and swelling should go away as well.

Axial arthritis

Axial arthritis is also known as spondylitis. It affects the lower spine and sacroiliac joints in the pelvis. Symptoms can begin months or even years before an ulcerative colitis diagnosis. Axial arthritis can cause the bones of your spine to fuse together, limiting your movement.

Ankylosing spondylitis

This is a more severe form of spinal arthritis. It can affect your flexibility, making your back stiff and bent over. This type of arthritis doesn’t improve when you treat ulcerative colitis symptoms.

The treatment your doctor recommends depends on the type of joint pain you have.

People can usually control peripheral arthritis pain and swelling with nonsteroidal anti-inflammatory drugs like ibuprofen (Motrin, Advil) or aspirin. These drugs can irritate the intestines and make inflammation worse, so they’re not usually a good option for people with ulcerative colitis.

Instead, your doctor might put you on one of these drugs, which bring down inflammation in both the joints and intestines:

  • steroid drugs, such as prednisone
  • the immune-suppressing drug methotrexate
  • disease modifying antirheumatic drugs, such as sulfasalazine (Azulfidine)
  • Tofacitinib (Xeljanz), a unique medication that reduces inflammation in people with ulcerative colitis. Its in a class of medications called Janus kinase inhibitors. It is also used to reduce inflammation in rheumatoid arthritis and psoriatic arthritis
  • biologic drugs, such as adalimumab (Humira), certolizumab (Cimzia), and infliximab (Remicade)

Biologic drugs also treat axial arthritis and ankylosing spondylitis. It’s important to stick with the treatment your doctor prescribes to prevent permanent joint damage if you have these more severe forms of arthritis.

In addition to taking medicine, you can try managing your joint pain with these home remedies:

  • Apply warm, wet compresses or a heating pad to achy joints.
  • Stretch the affected joints and do range-of-motion exercises. A physical therapist can show you the correct technique.
  • Ice and elevate the inflamed or swollen joint.

Remember to speak with your doctor before trying any home remedies.

You’ll likely need to visit a rheumatologist to treat your joint pain. A rheumatologist is an arthritis specialist. Your doctor will ask questions about your pain, such as:

  • when the joint pain started
  • what makes it better or worse
  • what it feels like
  • whether you also have swelling in the joints

Keep a journal of your pain for a week or two ahead of time. This can help you prepare for your appointment. Also, create a list of questions that you’d like to ask your doctor.

Your doctor will do some tests to find out whether you have arthritis or another condition that affects your joints. These tests can include:

  • blood tests for markers of inflammation or genes that are common in people with IBD and arthritis
  • joint fluid analysis
  • an MRI scan
  • X-rays

Arthralgia and peripheral arthritis pain should usually go away once your GI symptoms are under control. For axial arthritis and ankylosing spondylitis, you’ll need to take biologic drugs for pain and swelling.

Here are some things you can do that may help prevent joint pain:

  • Take your medicine exactly as your doctor prescribed, and don’t skip doses.
  • Follow a healthy diet. Ask your doctor for guidelines if you need help planning healthy meals.
  • Avoid foods that aggravate your ulcerative colitis. This may include spicy, high-fiber, high-fat, or dairy foods.
  • Stress can trigger ulcerative flare-ups, so practice relaxation techniques such as deep breathing to reduce your stress.

Read more: Foods to avoid with ulcerative colitis »